Department of Health

Central Luzon Center for Health and Development

JOSE B. LINGAD MEMORIAL REGIONAL HOSPITAL
EMERGENCY MEDICAL TEAM MANUAL OF OPERATIONS
EMERGENCY OBSTETRIC AND GYNECOLOGY Page No. Page 1 of 5

TITLE

Emergency Obstetric and Gynecologic Care

OBJECTIVES

1. To identify and manage complications accompanying normal spontaneous delivery and essential
newborn care.
2. To provide emergency care and management for obstetrical and gynecological cases.

SERVICES OFFERED

1. Prenatal Check-up.
2. Provision of emergency obstetrical care.
3. Manage and perform uncomplicated normal spontaneous delivery. (Cephalic Presentation of Primi
and Multi Gravida)
4. Provide initial and essential newborn care.
5. Initiate basic care for gynecological cases (Abnormal Uterine Bleeding, UTI, pelvic inflammatory
diseases, menstrual disorders) and other complications of pregnancies (e.g. eclampsia, pre-eclampsia,
ectopic pregnancies)

PERSON RESPONSIBLE

Nurse with training of EINC

Physician
Clinical Staff with training of BEmONC

LIMITATION

1. Management of pregnancies requiring Cesarean Section delivery.

2. Complicated deliveries with cord prolapsed, multiple births, breech and shoulder presentation.
3. Inability to perform blood transfusion for profuse bleeding.
4. Needed laboratory diagnostics may not be available. (e.g. ultrasound, chest x-ray)
5. Perform dilatation and curettage for abnormal uterine bleeding and any other complications.
6. Perform any vacuum or forceps assisted delivery.

LIST OF PROCEDURES

Obstetrical Cases
a. Normal Spontaneous Delivery (Cephalic Presentation)
b. Ectopic Pregnancy
c. Pre-Eclampsia and Eclampsia
d. Pre-natal Checkup

1. NOD obtain patient’s data, history, recent illness and initial vital signs which includes the
following:
1.1 Last Menstrual Period (LMP), Gestational Age and Obstetric Score
1.2 Expected Date of Delivery
 Department of Health
Central Luzon Center for Health and Development
JOSE B. LINGAD MEMORIAL REGIONAL HOSPITAL
EMERGENCY MEDICAL TEAM MANUAL OF OPERATIONS
EMERGENCY OBSTETRIC AND GYNECOLOGY Page No. Page 2 of 5

1.3 Previous Ultrasound result (if any)

1.4 Fetal Heart Rate
1.5 Temperature, Vital Signs, Respiratory Rate, Heart Rate, Blood Pressure, Oxygen
Saturation
1.6 ECG, CBG
2. Physician on duty provide initial assessment. (eg. Internal Examination, Fetal head position
and station)
3. Laboratory diagnostics applicable will be done (CBC with PC, Urinalysis with Pregnancy
Test, Fetal Doppler, RBS)
4. Initial explanation of the procedure should be given to the woman and her support people by
the Physician on duty. Obtained informed consent from the woman, if an assisted delivery is
required.
5. Provide treatment and care in delivering the newborn by Physician on duty assisted by NOD.
5.1 Provide patient privacy.
5.1.1 Placed on a delivery bed and position into lithotomy position. The bladder should be
emptied.
5.2 Maintain a clean and safe environment.
5.3 Performing delivery by Physician on duty and essential newborn care initiated by NOD
5.3.1 EINC principles should be follow and perform by NOD (see Annex)
5.3.1.1 Immediate thorough drying
5.3.1.2 Early skin to skin contact
5.3.1.3 Properly timed cord clamp
5.3.1.4 Non- separation of baby and mother for early initiation of breastfeeding.

6. NOD facilitates giving of prescribed medications by physician on duty

7. Physician on duty decides disposition.
7.1 Discharge to home
7.1.1 The Physician on Duty will accomplish discharge instructions form (see annex)
7.1.2 For referral and admission
Labor and Delivery
Performing uncomplicated normal spontaneous delivery and provide newborn care
1. Physician on duty assess urgent need for delivery. (e.g. Internal Examination, Fetal Doppler)
2. Maintain a clean and safe environment.
3. Provide patient privacy.
4. NOD assists the physician on duty and patient during labor and delivery.
5. NOD performs initial and essential newborn care following EINC principles:
5.1 Immediate thorough drying
5.2 Early skin to skin contact
5.3 Properly timed cord clamp
5.4 Non- separation of baby and mother for early initiation of breastfeeding.
6. Physician on duty decides disposition.
6.1 Discharge to home
6.1.1 The Physician on Duty will accomplish discharge instructions form (see
annex)
1.2 For referral and admission
6.2.1 Physician on Duty and NOD accomplishes referral form ( see annex)
 Department of Health
Central Luzon Center for Health and Development
JOSE B. LINGAD MEMORIAL REGIONAL HOSPITAL
EMERGENCY MEDICAL TEAM MANUAL OF OPERATIONS
EMERGENCY OBSTETRIC AND GYNECOLOGY Page No. Page 3 of 5

Gynecological Cases
a. Abnormal uterine bleeding
b. Menstrual Disorders (Amenorrhea, Dysmenorrhea, Menorrhagia)
c. Urinary Tract Infection
d. Pelvic Inflammatory Diseases

2. NOD obtain patient’s data, history and initial vital signs

3. Physician on duty assess the patient and note the severity of bleeding.
4. Laboratory diagnostics applicable will be done (CBC with PC, Urinalysis with Pregnancy
Test)
5. Provide applicable treatment and care.
6. NOD facilitates giving of prescribed medications by physician on duty
7. Physician on duty makes transport decision.

EXPIRATION
MEDICATION QUANTITY
(IF APPLICABLE)
Oxytocin 10 ampules
Dexamethasone 10 ampules
HNBB 10ampules
Paracetamol 300mg/amp 10ampules
Paracetamol 500mg/ tab 1 box
Magnesium Sulfate 100 ampules
Epinephrine 10 ampules
Nicardipine 10mg/amp 5 ampules
Lidocaine 10 polyampules
Vitamin K ampule 10 ampules
Erythromycin eye ointment 5 tubes
Folic Acid tablet 10 boxes
Ferrous sulfate 10 boxes
Ceftriaxone 1g/vial 10 vials
Insulin 1 vial
PNSS IL 10 bottles
D5LRS IL 10 bottles
D5Water IL 10 bottles
 Department of Health
Central Luzon Center for Health and Development
JOSE B. LINGAD MEMORIAL REGIONAL HOSPITAL
EMERGENCY MEDICAL TEAM MANUAL OF OPERATIONS
EMERGENCY OBSTETRIC AND GYNECOLOGY Page No. Page 4 of 5

Supply Quantity Expiration (if Applicable)

Syringe 1cc 3 boxes
Syringe 3cc 3 boxes
Syringe 5cc 3 boxes
Syringe 10cc 3 boxes
Abdominal Pack 100
Cotton 100
Sterile Gauze 100
Suturing set 2 sets
Betadine 10 bottles
Alcohol 10 bottles
Sterilium 2 bottles
Disposable gowns 50 pcs.
Mask 3 boxes
Clean Gloves 5 boxes
Sterile Gloves 5 boxes
Sterile Cord clamp 50 pcs.
Cotton tie 50 pcs.
Sutures 1box
Suction tip fr. 8 50 pcs.
Suction tip fr. 10 50 pcs.
Lubricating Jelly 1 box
Suction Connecting Tube 10 pcs.
Suction Machine 1 unit
BP Apparatus 1 unit
Thermometer 1 unit
Bassinette 1 unit
Glucometer 1 unit
CBG strips 100 pcs.
Soluset 10 pcs.
Macroset 10 pcs.
Microset 10 pcs.
IV cannula g.18 20 pcs.
IV cannula g.22 20 pcs.
IV cannula g.26 10 pcs.
Oxygen tank 5 tanks
Penlight 1
Weighing Scale 1
Oxygen Nasal Cannula (pedia) 5 pcs
Oxygen Nasal Cannula (neonate) 5 pcs
Oxygen Face Mask ( pedia) 5 pcs
Oxygen Face Mask (neonate) 5 pcs
Thermometer 1
Kidney Basin 1
Pulse Oximeter 1
 Department of Health
Central Luzon Center for Health and Development
JOSE B. LINGAD MEMORIAL REGIONAL HOSPITAL
EMERGENCY MEDICAL TEAM MANUAL OF OPERATIONS
EMERGENCY OBSTETRIC AND GYNECOLOGY Page No. Page 5 of 5

Nebulizer 1
Nebulization Kit 10
Droplight 5
Fetal Doppler 1 unit
Tape measure 1